Cisplatin is a chemotherapy drug that is given as a treatment for MANY types of cancer. It is most commonly used to treat testicular, bladder, lung, bone & soft tissue, oesophagus, head and neck, anal, stomach, cervix, and ovarian cancers. Cisplatin can also be given in combination with radiation as it can sensitise the cancer cells to the damaging effects of radiation. This information describes cisplatin, how it is given and some of its possible side effects.

What cisplatin looks like

Cisplatin is a colourless fluid.

How it is given

Cisplatin is given as a drip (infusion) through a fine tube (cannula) inserted into the vein. The infusion usually takes between six and eight hours because lots of fluid has to be given with it to flush through the kidneys. It may also be given through a central line (Hickman / Portacath), which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Cisplatin is sometimes given alongside other chemotherapy drugs as part of a combination regimen. Your nurse or doctor will discuss your treatment plan with you.

Possible side effects

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is given cisplatin, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug but which are not listed in this information, please discuss these with your doctor or chemotherapy nurse.

Feeling sick (nausea) and being sick (vomiting)

This is fairly common with cisplatin. If you do feel sick this may begin a few hours after the treatment is given and last for up a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce sickness. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective.

Your kidneys may be affected

Usually this does not cause any symptoms, and the effect is generally mild. But, if the effect is severe the kidneys can be permanently damaged unless the treatment is stopped. For this reason your kidneys will be checked by a blood test before each treatment.

You will be given fluid into a vein before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine that you pass. If you pass less urine than you usually do, it is important to tell your nurse or doctor.

If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid, before and after treatment, and it is important to do this. Let your doctor know if this is a problem, for example, if you are feeling sick.

Numbness or tingling in hands or feet

This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. The side effect usually disappears slowly a few months after the treatment ends.

Changes in hearing

You may have ringing in your ears (tinnitus) and may lose the ability to hear some high-pitched sounds. Again, this effect usually decreases when the treatment ends, although for a small number of people, it may be permanent. Tell your doctor if you notice any loss of hearing or tinnitus.

Temporary taste alterations

A dietitian or specialist nurse at your hospital can give advice about ways of coping with this side effect.

Less common side effects

Lowered resistance to infection

Cisplatin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels within 21–28 days.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding

Cisplatin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells)

While having treatment with cisplatin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Loss of appetite

The dietitian or specialist nurse can give you tips on boosting your appetite, and maintaining weight.

Diarrhoea

This can usually be easily controlled with medicines such as imodium (loperamide), but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Allergic reaction

Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness or darkening of the face, dizziness, headaches, breathlessness, anxiety, and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these.

Additional information

Risk of blood clots

Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility

Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss your fertility with your doctor before starting your treatment.

Contraception

It is not advisable to become pregnant or father a child while taking cisplatin, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

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ADDITIONAL INFORMATION FOR HEALTHCARE PROFESSIONALS

ADVERSE REACTIONS SIGNIFICANT

>10%:

• Central nervous system: Neurotoxicity: Peripheral neuropathy is dose- and duration-dependent.
• Dermatologic: Mild alopecia
• Gastrointestinal: Nausea and vomiting (76% to 100%)
• Hematologic: Myelosuppression (25% to 30%; mild with moderate doses, mild to moderate with high-dose therapy)
  • WBC: Mild
  • Platelets: Mild
  • Onset: 10 days
  • Nadir: 14-23 days
  • Recovery: 21-39 days
• Hepatic: Liver enzymes increased
• Renal: Nephrotoxicity (acute renal failure and chronic renal insufficiency)
• Otic: Ototoxicity (10% to 30%; manifested as high frequency hearing loss; ototoxicity is especially pronounced in children)

1% to 10%:

• Gastrointestinal: Diarrhea
• Local: Tissue irritation

<1% (Limited to important or life-threatening):

Anaphylactic reaction, arrhythmias, blurred vision, bradycardia, cerebral blindness, hemolytic anemia, liver enzymes increased, mild alopecia, mouth sores, optic neuritis, papilledema

BMT:

• Central nervous system: Peripheral and autonomic neuropathy, ototoxicity
• Endocrine & metabolic: Hypokalemia, hypomagnesemia
• Gastrointestinal: Highly emetogenic
• Hematologic: Myelosuppression
• Renal: Acute renal failure, increased serum creatinine, azotemia
• Miscellaneous: Transient pain at tumor, transient autoimmune disorders

MECHANISM OF ACTION

Inhibits DNA synthesis by the formation of DNA cross-links; denatures the double helix; covalently binds to DNA bases and disrupts DNA function; may also bind to proteins; the cis-isomer is 14 times more cytotoxic than the trans-isomer; both forms cross-link DNA but cis-platinum is less easily recognized by cell enzymes and, therefore, not repaired. Cisplatin can also bind two adjacent guanines on the same strand of DNA producing intrastrand cross-linking and breakage.

PHARMACODYNAMICS / KINETICS

• Distribution: I.V.: Rapidly into tissue; high concentrations in kidneys, liver, ovaries, uterus, and lungs
• Protein binding: >90%
• Metabolism: Nonenzymatic; inactivated (in both cell and bloodstream) by sulfhydryl groups; covalently binds to glutathione and thiosulfate
• Half-life elimination: Initial: 20-30 minutes; Beta: 60 minutes; Terminal: ~24 hours; Secondary half-life: 44-73 hours
• Excretion: Urine (>90%); feces (10%)